Abstract

Objective: Contemporary ethical accounts of the patient-provider relationship emphasise respect for patient autonomy and shared decision
making. We sought to examine the relative influence of involvement in decisions, confidence and trust in providers, and treatment
with respect and dignity on patients’ evaluations of their hospital care.

Design: Cross-sectional survey.

Setting: Fifty one hospitals in Massachusetts.

Participants: Stratified random sample of adults (N=27 414) discharged from a medical, surgical, or maternity hospitalisation between January
and March, 1998. Twelve thousand six hundred and eighty survey recipients responded.

Main outcome measure: Respondent would definitely be willing to recommend the hospital to family and friends.

Results: In a logistic regression analysis, treatment with respect and dignity (odds ratio (OR) 3.4, 99% confidence interval (CI)
2.8 to 4.2) and confidence and trust in providers (OR 2.5, CI 2.1 to 3.0) were more strongly associated with willingness to
recommend than having enough involvement in decisions (OR 1.4, CI 1.1 to 1.6). Courtesy and availability of staff (OR 2.5,
CI 2.1 to 3.1), continuity and transition (OR 1.9, CI 1.5 to 2.2), attention to physical comfort (OR 1.8, CI 1.5 to 2.2),
and coordination of care (OR 1.5, CI 1.3 to 1.8) were also significantly associated with willingness to recommend.

Conclusions: Confidence and trust in providers and treatment with respect and dignity are more closely associated with patients’ overall
evaluations of their hospitals than adequate involvement in decisions. These findings challenge a narrow emphasis on patient
autonomy and shared decision making, while arguing for increased attention to trust and respect in ethical models of health
care.

Footnotes

↵* The questions on treatment with dignity and respect and on having enough say about treatment were initially included in the
“Regard for patients” dimension. For purposes of this analysis, however, they were removed and considered separately.

↵† The questions about confidence and trust in doctors and in nurses were initially included in the “Emotional support” dimension.
For purposes of this analysis, however, they were removed and considered separately.